News and Views

News & Views is published quarterly by the Department of Nursing and Patient Care Services of the University of Maryland Medical Center.

news
views
Spring 2013
A Publication of the
Department of Nursing and
Patient Care Services
University of Maryland Medical Center
I Am a Boston Marathon Nurse
Alexander E. Halstead, BSN, RN, CCRN, Clinical Nurse II, Surgical Intensive Care Unit
Editor’s Note: There are no words to accurately describe the personal and physical
devastations that resulted from the bombings at the 2013 Boston Marathon.
Several Medical Center staff participated as runners and miraculously avoided
physical trauma, although the emotional scars will remain for a life time.
In addition, UMMC was honored that one of our nurses from the Surgical
Intensive Care Unit, Alexander E. Halstead, BSN, RN, CCRN, Clinical Nurse
II, acted as a medical volunteer for the marathon. Halstead has received local
and state recognition for his heroic involvement on the UMM.edu website and
on WBAL-TV, an NBC-affiliated Maryland television station. The account of
this tragic day is provided in the following story.
On April 14, 2013, I hopped onto a northbound plane to return
home to Boston to see family and again volunteer my services
for one of the biggest events of the year. I am a marathon
nurse. That doesn’t mean I run the marathon. I volunteer to
provide medical care to runners after they finish the race.
This was my fourth consecutive year with the Boston Marathon.
I grew up in Framingham, MA, so the Boston Marathon has
always been part of my life. I started volunteering while still in
nursing school at the University of Massachusetts in Amherst. I also
worked as an EMT on campus, and in the ER at Baystate Medical
Center in Springfield. Soon after graduating, I moved to Baltimore to
embrace an opportunity to work in the Surgical ICU at the University
of Maryland Medical Center. However, I always go back to
volunteer for the Boston Marathon.
On Sunday, April 14, the day before this year’s
marathon, I went out to breakfast with my family, caught
up with old friends, and rested up for the exhausting
day that was to follow. Marathon Monday! I arrived
in downtown Boston to prepare for my day. As in previous
years, I spent the morning with my fellow volunteers and
some of Boston’s leading sports medicine physicians, who gave us valuable information for
treating runners. They explained the treatment protocols and some of the ailments we might
come across. We picked up our marathon jackets and we were dismissed to get lunch. Boston
does marathon medicine right! The medical tents are massive air-conditioned structures with
televisions, hundreds of cots, a laboratory section, and multiple other resources.
We prepared our respective sections of the tent to receive runners. Each section was
made up of a physician, a few nurses, a physical therapist, and a few podiatrists – a truly
well-rounded medical team.
The cheering began as the wheelchair winners were the first to cross the finish line, and
some of them passed through our tent on their way to the Copley Square Hotel. Soon after, the
men and women elite runners walked through the tent after their amazing feat – usually
needing minimal care because they train so well.
At 12:30 p.m., the runners started trickling in as patients. The high predicted temperature
was 54 degrees, so we expected a slow day in the tent. In my section, we saw runners for a
continued on page 15.
Lisa Rowen’s Rounds:
Vascular Surgery
Progressive Care
Unit
Lisa Rowen, DNSc, RN, FAAN,
Senior Vice President and
Chief Nursing Officer, Nursing
and Patient Care Services
The Vascular Surgery Progressive Care
Unit is aptly named – it is, indeed,
progressive. Whether it is a new initiative
to increase hand hygiene, increase staff
ownership or decrease patient falls, or
simply approaching any challenge with a
can-do attitude, this unit is innovative and
engaged. The staff members’ enthusiasm
and positivity are infectious. Their desire
and efforts to continuously improve patient
care extend well beyond the walls of
their unit. Please read on to understand
why I have chosen the Vascular Surgery
Progressive Care Unit, also known as
Gudelsky 5 East (C5E), to receive the annual
CNO Team Award for Extraordinary Care.
I arrived on C5E during Quiet Hour,
which occurs daily from 1 to 2 pm and 1 to 2
am. The lights were dimmed and the voices
were hushed. Virginia Nganga, BSN, RN,
Senior Clinical Nurse I, explained Quiet Hour
was initiated in January to address patient
complaints of noise on the unit interfering
with their rest. Breaking the silence, a bed
alarm rang. Every single staff member,
including the nurse manager, Simone
Odwin-Jenkins, MBA, BSN, RN, started
sprinting to the room where the alarm
was sounding. The reason was not
continued on page 6.
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Spring 2013
In This Issue
1
1
2
3
4
5
7
8
8
11
12
14
15
16
17
18
19
20
22
24
I Am a Boston Marathon Nurse
Lisa Rowen’s Rounds
Corporate Compliance
CRISP for Our Patients
Informatics & The Epic Project
Role of the Ambulatory Nurse
UMMC Healing Arts Exhibit
Core Measures
Improving Vascular Outpatient Flow
you&ummc: Welcoming New Nurses
Nurses Week 2013
We Discover
Certification Corner
Improving Pain Management
NNPs in the Neonatal ICU
Nursing Governance Restructure
Spotlight on Pharmacy
Patient Family-Centered Care
Honorable Mention
Clinical Practice Update
Corporate
Compliance
Christine Bachrach, UMMS Vice President & Chief Compliance Officer
Toya Jackson, Director of Compliance
The Medical Center Compliance Program provides a short Frequently Asked Question (FAQ) in
each issue of News and Views. We are looking for new ways to reach out to employees to raise
awareness of compliance issues. Please let us know what you think, or suggest topics by emailing
compliance@umm.edu or tjackson4@umm.edu.
Compliance FAQ
Q: Does HIPAA allow me to speak with
the family or friend of a patient who
is incapacitated or experiencing an
emergency?
A: Generally yes, as long as the patient has
not expressly restricted information from
being discussed with a particular person.
If the patient is deemed incapacitated or is
experiencing an emergency, HIPAA allows
for professional judgment in allowing
providers to speak with family and friends
about care, if it is in the best interest
of the patient. Some examples of this
would be assisting with health history,
current condition, discharge, or follow-up
appointments, etc. It would also be allowed
in order to assist the hospital in receiving
payment for services rendered.
Find News&Views online at http://www.umm.edu/nursing/newsletter.htm and on the UMM Intranet at intra.umm.edu/ummc/nursing-dept/newsviews.htm
Editor
Anne E. Naunton, MS, RN-BC
Professional Development Coordinator
Clinical Practice and
Professional Development
Editorial Board
Susan S. Carey, MS
Professional Development Coordinator
Clinical Practice and
Professional Development
Mary Ellen Connolly, MS, CPNP
Pediatrics
Suzanne Leiter
Executive Assistant to the Senior Vice
President and Chief Nursing Officer,
Nursing and Patient Care Services
Greg Raymond, MS, MBA, RN
Director, Nursing and Patient Care Services
Clinical Practice, Professional Development,
Neuroscience, Behavioral Health and
Supplemental Staffing
Lisa Rowen, DNSc, RN, FAAN
Senior Vice President and
Chief Nursing Officer, Nursing and
Patient Care Services
Mihae Shin-Diep, MS, CRNP
Interventional Radiology
News & Views is published quarterly by the Department of Nursing and Patient Care Services of the
University of Maryland Medical Center.
Scope of Publication
The scope of News & Views is to provide clinical and
professional nursing practice topics that focus on inpatient,
procedural, and ambulatory areas.
Submission Guidelines
Send completed articles via e-mail to anaunton@umm.edu.
Please follow the guidelines provided below.
1. Font – Times New Roman – 12 pt. black only.
2. Length – Maximum three double spaced typed pages.
3. Include name, position title, credentials, and practice
area for all writers and anyone named in the article.
4. Authors must proofread the article for spelling, grammar,
and punctuation before submitting.
5. Provide photos and embedded images in separate .jpg files.
6. Submit trend data in graphic format with labeled axes.
7. References must be numbered consecutively and
provided at the end of the article.
8. Editor will seek expert review of articles to verify and
validate content.
9. Articles will be accepted based on appropriateness of
content and availability of space in each issue.
10. Articles that do not meet the above guidelines will be
returned to the author(s) for revision and resubmission.
Issue
Summer 2013
Fall 2013
Winter 2014
Spring 2014
Due Date
July 8, 2013
October 7, 2013
January 6, 2014
May 12, 2014
Displaying Credentials
The UMMC Standard for displaying of credentials is
based on the ANCC Guidelines.
The preferred order is:
• highest earned degree (can list more than one if
in different fields)
• licensure
• state designations or requirements
• national certifications and honors
• other recognitions
Nurses with two or more nursing degrees (MSN, BSN)
should only list their highest nursing degree, along with
other degrees obtained. Example: Betty Smith, MSN,
MBA, RN.
Why this order: The education degree comes first because
it is a “permanent” credential, meaning it cannot be taken
away except under extreme circumstances. The next two
credentials (licensure and state designations/requirements)
are required for you to practice. National certification
is sometimes voluntary. Awards, honors, and other
recognitions are always voluntary.
If you would like additional information, please visit
http://www.nursecredentialing.com and search using
the word “credentials.”
news
&views
Chesapeake Regional Information System
for our Patients (CRISP)
Cheryl C. Williams, MSN, RNC-NIC, MBA, Nurse Informaticist, Clinical Informatics & The EPIC Project
If you will, imagine the following scenario as an example. Jane Doe is employed at ABC Facility, Inc. She was not
feeling well when she arrived to work. Shortly after arrival, Jane was found unconscious in the staff rest room by a
co-worker. When the EMTs arrived, no one was able to give a description of what happened or report on Jane’s medical
history. She arrived at University of Maryland Medical Center via ambulance and was unable to give the caregiver any
information. As a provider of nurse caring for the patient, you are able to quickly access her medical health history and
use that information to help diagnose and treat her condition. Where did this important information come from …
a health information exchange called CRISP.
Today’s healthcare arena is plagued with a staggering influx of
patients who often go to multiple providers to receive care. This
practice often leads to unnecessary repeated lab work, radiologic
testing, conflicted prescription orders, and backlogs in ERs and
physician offices. The lack of knowledge of past medical history can
lead to higher risks to patient safety, increase in healthcare costs,
and the reduction in a provider’s available time to treat critical cases.
In 2009, through an effort to minimize cost, time, and improve
patient safety, the Maryland Healthcare Commission designated
Chesapeake Regional Information System for our Patients (CRISP)
as Maryland’s statewide Health Information Exchange (HIE). The
mandate for CRISP is to electronically connect all healthcare
providers in the state of Maryland. The question at hand is why
would the process of contributing and utilizing an HIE be beneficial
to providers?
A Health Information Exchange is the technology that supports
the flow of health information among physician practices, hospitals,
labs, radiology centers, and other healthcare institutions. In the state
of Maryland, there are 46 acute care hospitals, each agreeing to
work with CRISP in sharing patient data. Data points include patient
demographics, lab results, radiology reports, and electronic reports.
Currently, the Medical Center shares patient demographics and
electronic reports with the system.
CRISP offers a free web-based portal to access patient data
through the HIE. Information can be printed and incorporated into
records, which allow physicians and support staff to query patients
for whom they are providing care. There is also the ability to view lab
results, radiology reports, and other transcribed documents for that
patient. Clinical information shared with CRISP is made accessible in
real time. The electronic exchange of data provides:
◗◗ A more complete view of the patient.
◗◗ Improved efficiency, as less time is spent locating
previous records and logging into multiple data sources.
◗◗ Enhanced reimbursement leveraged through electronic
patient records and e-prescribing, which will soon be
federally mandated.
◗◗ Coordinated care, as clinicians are able to view patient
encounters from other providers.
◗◗ Access to real time clinical information from all CRISP
participants that includes lab results, radiology reports,
discharge summaries, history and physical information,
consultations, and operative notes.
Care providers can become
authorized users of CRISP in four
easy steps:
1. Complete an online user request form at www.hie.crisphealth.org
2. Complete the CRISP training via an online WebEx session.
3. Submit a photo ID.
4. Be verified by the point of contact in the organization.
Once all of the above conditions are met, CRISP will email a
username and password directly.
Additional benefits of CRISP include the Encounter Notification
System (ENS) and direct messaging. ENS is a real time alert of
when a patient is admitted to the hospital. Real-time information
allows providers the opportunity to closely track their patient
population. Tracking information includes patient admissions,
intra-facility transfers, and discharges in the state of Maryland.
Direct secure messaging can be used to communicate referrals
and visit summaries between ambulatory practices, to send clinical
information between ambulatory practices and hospitals, to make
formal request for medical records, and to receive encounter alerts
from the CRISP ENS.
CRISP benefits the patient by improving the care delivery
process. Patients may be seen more quickly. Diagnosis and
interventions may be more effective through provider access to
both real time and historical clinical data. Readily available results
may decrease the need for duplicate tests and procedures and may
reduce medical mistakes and unnecessary costs.
UMMC and other Maryland acute care facilities have chosen
CRISP to improve patient safety, minimize healthcare costs, and save
time. For more information on CRISP, please visit www.crisphealth.org.
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4
Spring 2013
Informatics & The Epic Project …
Sailing into Portfolio
Brooke L. Gaskins, MS, RN, CNL, Nurse Informaticist, Clinical Informatics & The Epic Project
On March 11, 2013, UMMC held its kick-off event to
introduce Epic Portfolio, an integrated electronic medical
record, which will take the Medical Center into a new era
of electronic documentation.
What is EPIC Portfolio?
EPIC is a state-of-the art integrated electronic information system
that combines many aspects of a patient’s medical history into a
single application. A medical record in Epic Portfolio will include
data from participating ambulatory, outpatient, and inpatient
records, resulting in a more comprehensive medical record. This will
improve a clinician’s ability to treat patients based on complete and
updated information. Regardless of the location of care, inpatient or
outpatient, providers will be able to document in the same system.
Most importantly, patients will have one integrated medical record
that can be accessed and continuously updated, whether they are
in the ICU or in an outpatient setting. Clinicians will be able to view
the patient’s medical history, allergies, current medications, all test
results, and progress notes as soon as they are available. Portfolio will
allow providers to communicate directly with other physicians about
a patient, and even place orders remotely 24 hours a day, enhancing
patient care delivery. Once the system is fully implemented, patient
information will be seamlessly integrated and freely flowing between
the University of Maryland Medical Center, Baltimore Washington
Medical Center, University of Maryland St. Joseph Medical Center,
University of Maryland Medical Center Midtown Campus, and Kernan.
Stages of the Implementation Process
Stage 1: Planning and Discovery is the phase in which the Clinical
Informatics team and Information Services and Technology (IS&T)
work closely to define the project plan and timeline, determine
project scope, define the project governance structure and key
participants, assess current workflow, and conduct introductory
discovery sessions and site visits.
Stage 2: Validation is the phase in which the team verifies workflows
and compares them to the EPIC Portfolio build. Workflows that do
not fit the build of EPIC Portfolio will be flagged. These disparities
will be addressed through collaboration and joint decision making
with the Clinical Informatics team, IS&T, and key stakeholders.
Clinicians from each service line will be brought together to provide
feedback on processes and workflows that will be reflected in the
Portfolio build.
Stage 3: Build occurs when IS&T builds or develops the system.
Analysts program the system and configure it to look and function as
directed by clinicians. Some examples of build include amending the
appearance of flow sheets to meet the needs of unique clinical areas.
Stage 4: Testing and Training is a multi-step process. Users
perform unit testing of specific applications on their respective
units. Integrated testing is conducted to ensure all applications
in the system are working as a whole. Usability labs are held to
allow experts from clinical units to test the system for ease of use.
Experts navigate the system as they would in daily practice to detect
problems with the design and build. Finally, all staff will attend
Portfolio training in preparation for the go-live.
Stage 5: Go-Live is the long-awaited event when the system is
turned on and each of the hospitals begins using the applications.
Round-the-clock unit support is provided. Super-users are available on
the units to assist staff in real time and are in constant communication
with the IS&T command center to address staff questions and concerns.
Stage 6: Optimization takes place after implementation. The
implementation timeline is aggressive, resulting in a basic system
at onset. After go-live, additional applications will be brought on
line and existing applications will be modified and refined based on
clinician input after a period of use to create an optimized or more
robust system.
continued on page 5.
Benjamin Laughton
MBA, MSN, CRNP
Senior Director,
Clinical Informatics &
The Epic Project
news
&views
The Role of
the Ambulatory Nurse
Joji Patterson, BSN, RN, Nurse Manager, Neurology Ambulatory Center
Monika Bauman, MSN, RN, Nurse Manager,
Women’s and Children’s Ambulatory Services
Ambulatory Care is a unique, specialized field of nursing that spans
various clinical settings within UMMC, including outpatient clinics,
procedural areas, infusion centers, and transitional care. In addition
to expertise in ambulatory care, nurses practice in diverse and
multifaceted subspecialty roles within neurology, otolaryngology,
oncology, pediatrics, diabetes/endocrinology, cardiology, HIV/
infectious disease, surgery, urology, gastroenterology, transplant,
radiology, women’s health, and psychiatry.
Relationship-based care is at the core of ambulatory nursing
practice at the Medical Center, as it continues from an inpatient
level of care to the outpatient arena. This care delivery model
emphasizes the development of collaborative relationships as one
of the foundations to provide excellent patient care. The ambulatory
nurse practices collaboratively with the physician, social work
services, rehabilitation services, home care agency, and community
organizations to address the needs of the patient and caregiver.
As patients seek care for health related problems or seek
assistance with health maintenance and/or health promotion,
ambulatory nurses must be uniquely qualified as well as autonomous
providers of patient care. Communication between the nurse and the
patient may take the form of a visit and/or telephone encounters,
with emphasis on educating the patient and family towards selfefficacy to manage symptoms of acute and/or chronic conditions
and maximize wellness. Sometimes the emphasis is on assisting the
patient and family to obtain insurance authorization for access to
medication or treatment, finding resources for the underinsured,
and coordinating care services.
Epic Portfolio
continued from page 4.
How will EPIC Portfolio benefit the
University of Maryland Medical System?
◗◗ Improve patient safety and quality of care by providing a single
secure electronic record
◗◗ Provide a comprehensive approach to the complex issues of
safe and effective medication use
◗◗ Route diagnostic testing results to the appropriate caregivers in
a timely manner
◗◗ Allow for secure communication with patients to include
access to lab results, medication refills, and scheduling of
appointments
◗◗ Improve communication within offices and between
environments of care – office to office and hospital to office
◗◗ Help nurses organize their work to ensure that patient care
activities are provided across all disciplines and shifts
◗◗ Assist the hospitals with registering patients, managing the
inpatient stay, and billing for services.1
Telehealth nursing practice within ambulatory is unique and
presents its own challenges. Nurses must be versed with their scope
of practice and the use of evidence-based resources to manage the
patient through telephone triage. For example, astute interviewing
skills with the application of the nursing process and critical thinking
skills are essential in the management of a patient without the
customary face-to-face encounter.
The role of the ambulatory nurse is evolving in response to the
many initiatives of healthcare reform. The need for nurses to be in
the forefront of health promotion and disease prevention is evident,
as the complexity of patients seen requiring extensive patient and
family education is greater. With the changing healthcare landscape, the
ambulatory nurse is emerging with an expanded role that is responsive
to patient care across the continuum, with the goal of improving patient
outcomes and averting patient readmission. Ambulatory nurses are in
the forefront to ensure continuity of care and coordination of services
as the patient flows from inpatient discharge to entry in the outpatient
setting to a return to the community.
The interest in ambulatory nursing at the Medical Center
continues to grow as a specialty area, and more nurses are pursuing
this practice setting for professional employment. The Ambulatory
Professional Development Council (PDC) conducted a survey
across the ambulatory clinical specialties and found the following
characteristics:
◗◗ Educational background - BSN 68%; MSN 26%
◗◗ Academic Enrollment - 13%
◗◗ Advanced Certification - 24%
The ambulatory PDC is actively communicating professional
development opportunities to ambulatory nurses. The goal is to
promote the professional advancement of the ambulatory nurse.
If you would like additional information about the unique field
of ambulatory nursing, visit the American Academy of Ambulatory
Care Nursing at www.aaacn.org. Additionally, the advanced
certification examination in ambulatory care is administered by the
American Nurses Credentialing Center, and information is provided
at www.nursecredentialing.org.
The implementation of EPIC applications will span both
inpatient and outpatient areas. Each application has a unique name
specific to the area of focus:
◗◗ ASAP (Emergency Department)
◗◗ Clinical Documentation (Inpatient)
◗◗ OpTime (Operating Room)
◗◗ Radiant (Radiology)
◗◗ Stork (L&D, Mother/Baby)
◗◗ Willow (Pharmacy)
◗◗ Security (Access)
◗◗ Cadence (Scheduling)
◗◗ Clarity (Reports)
◗◗ HIM (Health Information Management)
◗◗ Prelude (Bed Management)
The execution of the EPIC system will be a massive undertaking and
will touch every employee within the Medical System. However, with
the input and support from the UMMS team, this will surely be a
successful EPIC adventure!
For more information, please feel free to contact the Clinical
Informatics team at ClincalInformatics@umm.edu.
1
Yale New Haven Health System. Yale New Haven Hospital. 2011.
https://projectepic.ynhh.org/Pages/FAQs.aspx (accessed 3/9/13).
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Spring 2013
Rounding Report
continued from page 1.
to silence the alarm but rather to ensure the patient would not fall.
The staff members on C5E take falls seriously and personally. They all
feel accountability for their patients’ fall data and each of them can
tell you how many days have gone by without a patient fall.
The staff members used several strategies that led to success
in reducing the number of falls on C5E from an average of 15 falls per
quarter to three falls per quarter. About 18 months ago, Virginia led a
small group to create a Falls Board (see below) that tracks each day
of the month; highlights the number of days without a fall; offers falls
updates; lists the protocol in the event of a fall and a tool for a postfall huddle; provides goals and expected outcomes, action plans and
interventions; and lists the members of the Falls Committee. As of
March 31, the team and patients had gone 62 days without a fall –
great work!
In addition, the team on C5E performs a huddle twice a day.
During these huddles, they discuss:
◗◗ Falls: High-risk patients are identified, specific interventions are
listed and they double check to ensure the bed alarm is on.
◗◗ Wounds: High-risk patients are identified and someone checks
to ensure the wound/ostomy nurse has seen these patients; the
medical record for every wound is checked to ensure a dressing
order is written and performed with consistency.
◗◗ Urinary Catheters: All catheters are assessed to determine if they
are still required or can be discontinued (per protocol).
◗◗ Central Lines: All central lines are assessed to determine whether
they can be discontinued (per order).
◗◗ Drips: All drips are quickly listed; times for the next PTT are
mentioned.
◗◗ Walking Buddy: Another innovation!
The C5E team uses a huddle worksheet that is included with this
rounding report.
The Walking Buddy is a new, joint initiative on C5E with our
colleagues from Rehabilitation Services. Eight nurses and patient
care techs have been trained by the Rehab staff in a Train the Trainer
program, which has a goal of mobilizing the patients earlier in their
hospitalization. As most of the patients on the unit are on the Vascular
Surgery Service, early and safe mobilization is important for their
recovery. The 8 Mobility Champions have been trained on lifts and gait
belts and have a goal of safely getting patients out of bed every day
by 11 am. As the remainder of the staff members are trained, they will
no longer need to wait for a rehab therapist to mobilize their patients
for the first time out of bed following a surgical procedure.
This initiative has just started, and the Mobility Task Force
will start tracking metrics to study compliance with their goals and
whether earlier discharges occur from the intervention.
As I heard about this initiative, I asked, “How is it possible that
you all are involved in so many innovative processes?”
Virginia replied, “Simone pushes us. We all write our goals and
she enforces that a timeline is placed on our work.”
I responded with a question: “Do you have even more goals as a
team then what we’ve discussed?”
Absolutely! Virginia shared C5E’s new goal of 100% Med-Surg
certification for all of the nurses. To achieve this lofty goal, the nurses
have formed a study group and are reviewing all of the systems, one
session at a time. Katrina Daye-Whitehead, BSN, RN, PCCN, Clinical
Nurse II, is the chair and champion of the certification initiative.
All C5E staff members, regardless of role, are expected to be
a member or leader of a unit-based committee. Members vote on
the chairs of their many unit-based committees. Once elected, the
committee chair campaigns for staff members to join that committee.
It is a competitive process to engage their colleagues for their
committees and they enthusiastically appeal to others to join.
Victoria Phelps, BSN, RN-BC, Senior Clinical Nurse I, created a
“campaign poster” to invite colleagues to join the Quality and Safety
Committee. Talk about staff engagement!
In addition, one of the committees is totally focused on
employee engagement. The C5E C2X committee, chaired by
Darlene Bonner, BSN, RN, Clinical Nurse II, celebrates special events,
such as staff birthdays, years of service and awards received. For
example, the C2X Committee sponsored the Employee Recognition
Board in the staff break room. Bing Casal, BSN, RN, Senior Clinical
Nurse I, is pictured for receiving the Certificate of Distinction for
Outstanding Unit Leader from the Philippine Nurses Association
and Biljana Brkic, RN, Clinical Nurse II and Nana Musa, BSN, RN,
Clinical Nurse II, are pictured on this board for their years-of-service
recognition. Darlene explained the team is planning celebrations
during Nurses Week and Administrative Assistants Day, April 24. They
will also recommend names of colleagues to Simone for a unit-based
Employee of the Month. During this month, the C2X committee is
focusing on NDNQI data and patient satisfaction via HCAHPS data.
Of the past five months, C5E has scored above the Medical Center
and national average for patient satisfaction. The staff is clearly doing
many things the right way and you can sense it in their attitudes
about their work and each other.
The teamwork and care for each other is palpable on C5E.
Fredin Pallikal, RN, Clinical Nurse II, has been on the unit for two
years. He said, “I love this unit. The staff are great and very supportive.
We see a variety of patients and it’s always interesting.”
continued on page 10.
news
&views
1st annual national arts prograM®
uMMC healing arts exhibit
FOr EmplOYEEs & FAmiliEs
Calling all artistically talented staff and their family members! UMMC’s newest
C2X team, the Healing Arts Team, has partnered with the National Arts Program®
to host our first employee art exhibition and awards reception at UMMC (22 South
Greene Street, Baltimore, MD 21201). The Healing Arts Team exists to provide
opportunities for integrating art into your daily lives, using art as a forum for
growth, self-expression and healing.
Mark your Calendars!
registration: Now – August 23 via The National Arts Program® website
www.umm.edu/arts
artwork drop off: October 3 – 4 • 7 – 10 am & 3 – 6 pm
All participants will be contacted via email with drop off locations
reCeption (open to all): October 9 • 5 – 7 pm • Gudelsky Wall of Honor
exhibit dates: October 9 – October 23 • Weinberg Atrium
artwork piCk up: October 24 – 25 • 7 – 10 am & 3 – 6 pm
All participants will be contacted via email with pick up locations
All UMMC employees, physicians, and their immediate family members are invited
to exhibit their artwork and compete for cash prizes sponsored by the National Arts
Program® in the following categories: Amateur Adult, Intermediate Adult, Professional
Adult, Youth 12 & Under and Teen 13–18. There is no entry fee, but all entries must be
the original work of the applicant, completed within the last three years.
For more information, visit umm.edu/arts,
the intranet, or contact rachel hercenberg,
Venue Coordinator, at 410-328-8893 or
rhercenberg@umm.edu.
Sponsored by the
C2X Healing Arts Team
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Spring 2013
Core Measures
What’s in Store for July 2013 and Beyond
Sylvia Daniels, BSN, RN, Manager, Regulatory Compliance & Outcomes
Since 2002, the Medical Center has collected, reported, and worked
to improve the quality of care provided to our inpatient population.
As early as July 2013, the Maryland Healthcare Commission will
require all Maryland hospitals to report data for the outpatient core
measure set. This measure set, developed by CMS, is intended to
provide a uniform set of quality measures to be implemented in the
hospital’s outpatient settings. The primary purpose of these measures
is to stimulate and support a significant improvement in the quality
of care for patients receiving services in the hospital outpatient
settings. The focus of this measure set is the adult and pediatric
emergency departments, ambulatory surgery, and services provided
in the diagnostic imaging department. This measure set is composed
of 3 types of measures – claims, structural, and abstraction.
The claims measures are those that will use the information
about an episode of care from our billing claims to determine
imaging efficiency in our use of CT scans, mammography, and
MRIs. The purpose of reporting these measures is to reduce
unnecessary exposure to contrast materials and/or radiation, ensure
adherence to evidence-based medicine and practice guidelines, and
to prevent wasteful use of resources. We will begin to submit data
in July 2013.
The claims measures are:
OP-8
OP-9
OP-10
OP-11
OP-13
• OP-14
• OP-15
•
•
•
•
•
MRI Lumbar Spine for Low Back Pain
Mammography Follow-up Rates
Abdomen CT – Use of Contrast Material
Thorax CT – Use of Contrast Material
Cardiac Imaging for Preoperative Risk Assessment
for Non-Cardiac Low Risk Surgery
Simultaneous Use of Brain CT and Sinus CT
Use of Brain CT in the Emergency Department
for Atraumatic Headache
The structural measures assess whether organizational resources
and arrangements are in place and used to deliver high-quality
health care, such as the number, type, and distribution of medical
personnel, equipment, and facilities. Aggregate data for these
measures are submitted once a year, beginning in July 2014.
The structural measures are:
• OP-12
• OP-17
• OP-22
• OP-25
• OP-26
The Ability for Providers with HIT to Receive
Laboratory Data Electronically Directly into Their
Qualified/Certified EHR System as Discrete
Searchable Data
Tracking Clinical Results Between Visits
Left Without Being Seen
Safe Surgery Checklist Use
Hospital Outpatient Volume Data on Selected
Outpatient Surgical Procedures
A Rapid Improvement Event to
Improve Vascular Outpatient Flow
M. Patricia Wall, BSN, RN, CCRN, Senior Clinical Nurse II, Interventional Radiology
“A Rapid Improvement Event (RIE) To Improve Vascular Outpatient Flow Through Interventional Radiology” is the title
of a poster presented on April 16, 2013 at the Association of Imaging and Radiology Nursing (AIRN) Convention held
in New Orleans. An RIE, rapid improvement event, is a weeklong interdisciplinary team event where participants rapidly
learn and apply lean principles to streamline processes and decrease waste.
At the University of Maryland Interventional Radiology Department,
inefficiencies in patient pre-procedure preparation created delays in
outpatient flow across the continuum of care. This issue was made
apparent by a decrease in patient satisfaction scores related to wait
times for procedures. In interventional radiology (IR), we looked at
increasing patient and staff satisfaction by decreasing inefficiencies
in the time spent admitting patients pre-procedure. The team was
made up of a dynamic variety of members ranging from a senior
vice president to a patient transporter. Various members of the IR
department were involved, as well as “fresh eyes” from other
hospital departments.
The RIE team spent one week dedicated to identifying issues
related to patient prep and flow. Out of this weeklong event came
several practice changes that were implemented as rapid experiments.
These included a new chart system, a pre-procedure checklist,
defined expectations for referring physicians, and standard work
for staff. These rapid experiments produced a more efficient and
organized department. We look forward to performing additional
rapid improvement events to increase our efficiency and decrease
overall waste.
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The abstraction measures are detailed in the table that follows.
They will focus on the care of AMI, chest pain and stroke patients
in the ED, ED throughput (timeliness and efficiency), pain
management for patients with long bone fractures in the ED, and
outpatient surgery. Data for these measures will be abstracted from
the patientsâ&#x20AC;&#x2122; medical records starting in January 2014.
Measure
Rationale
OP-1 Median Time to Fibrinolysis
Time to fibrinolytic therapy is a strong predictor of outcome in patients with an
acute myocardial infarction.
OP-2 Fibrinolytic Therapy Received within
30 Minutes of ED Arriva
Time to fibrinolytic therapy is a strong predictor of outcome in patients with an
acute myocardial infarction.
OP-3 Median Time to Transfer to Another
Facility for Acute Coronary Intervention
The early use of primary angioplasty in patients with ST segment elevation
myocardial infarction (STEMI) results in a significant reduction in mortality and
morbidity.
OP-4 Aspirin at Arrival
The early use of aspirin in patients with AMI results in a significant reduction in
adverse events and subsequent mortality.
OP-5 Median Time to ECG
Guidelines recommend patients presenting with chest discomfort or symptoms
suggestive of STEMI have a 12-lead electrocardiogram performed within a target of
10 minutes of emergency department arrival.
OP-6 Timing of Antibiotic Prophylaxis
Multiple studies have demonstrated that timing is critical to the effectiveness of
surgical antimicrobial prophylaxis. Current guidelines recommend dosing within one
hour before incision.
OP-7 Prophylactic Antibiotic Selection for
Surgical Patients
A goal of prophylaxis with antibiotics is to use an agent that is safe, cost-effective,
and has a spectrum of action that covers most of the probable intra-operative
contaminants for the operation.
OP-18 Median Time from ED Arrival to ED
Departure for Discharged ED Patients
Reducing the time patients remain in the emergency department (ED) can improve
access to treatment and increase quality of care.
OP-19 Transition Record with Specified
Elements Received by Discharged Patients
Providing a detailed transition record at the time of ED discharge enhances the
patientâ&#x20AC;&#x2122;s preparation to self-manage post-discharge care and comply with the
post-discharge treatment plan.
OP-20 Door to Diagnostic Evaluation by a
Qualified Medical Personnel
Reducing the time patients remain in the ED can improve access to treatment and
increase quality of care.
OP-21 Median Time to Pain Management for
Long Bone Fracture
Pain management in patients with long bone fractures is undertreated in EDs.
ED pain management has room for improvement.
OP-23 Head CT or MRI Scan Results for
Acute Ischemic Stroke or Hemorrhagic
Stroke Patients who Received Head CT or
MRI Scan Interpretation within 45 Minutes of
ED Arrival
Improved access to diagnostic imaging assists clinicians in the decision-making
process and treatment plans. Decreasing radiology turnaround times will enhance
decision-making capabilities for patients with TIA or Acute Ischemic Stroke.
OP-24 Cardiac Rehabilitation Patient
Referral from Outpatient Setting
Cardiac rehabilitation is increasingly recognized as an integral component of
the continuum of care for patients with cardiovascular disease. Despite the
documentation of substantial morbidity and mortality benefits, cardiac rehabilitation
services are vastly underutilized. This measure offers the potential to enhance
referral to, enrollment in, and completion of cardiac rehabilitation.
Nurses play a key role in impacting patient outcomes and
improving the processes of care. Since the focus of the outpatient
measures is timeliness and efficiency, it will be important for
physician orders to be implemented in a timely manner and for
documentation to reflect the accuracy and timeliness of care
provided. Nurses will directly impact such outpatient measures
as patients receiving discharge instructions following an ED
visit, the timely administration of pain medication and aspirin,
and EKGs being done in a timely fashion for patients with
chest pain.
9
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Spring 2013
Rounding Report
continued from page 6.
Virginia echoed Fred’s comments and also said, “I love this unit! I love
this unit! We were on 3D before and we’ve had a change in our patient
population and environment. When we moved to C5E, we put a lot of
initiatives in place and have seen great results. The culture of the unit
is positive and our manager listens to us.”
The “feel” of the culture is evident on the unit’s large C2X
Bulletin Board, visible as you enter the unit. On the bottom row, where
each unit can customize the information with its own content, you can
find the following under the pillars:
◗◗ People: New C5E employees are pictured.
◗◗ Service: Patient satisfaction results are listed. The team is
especially proud that its pain management scores have been
above the 90th percentile for each quarter of the past year.
After an intensive re-education about assessment of breakthrough
pain, they were able to see significant improvement in the
HCAHPS data.
◗◗ Safety & Quality: In The Quality Management Briefing, a System
newsletter about quality, C5E is featured for its work on hand
hygiene.
◗◗ Stewardship: The successful Medical-Surgical toy drive, which
raised more than 300 gifts for children, is listed.
◗◗ Innovation: The Quest, a staff newsletter edited by Victoria Phelps
and Katrina Daye-Whitehead, was just launched. The Quest, in its
inaugural issue, encouraged the staff to get involved and described
all the unit-based committees.
Vascular Surgery Progressive Care Unit Team Members
In addition to the aforementioned C2X Committee, C5E has
robust committees in place for Clinical Practice, Education, and Safety
& Quality. Simone Odwin-Jenkins said, “We have revamped all of our
unit-based committees to make them purposeful with measurable
goals.” Simone speaks with energy and focuses on excellent outcomes.
She is described by the group as someone who listens well and is
open to change. She said, “I tell the team what I’m thinking about
and they are so creative, they can take my vision to places I hadn’t
dreamed of. I like the Magnet concept, with centrally strong shared
governance. A member of each of our four, big unit-based committees
attends the hospital-wide corresponding committee and brings back
the information and education to our whole team. The group is open,
flexible and readily embraces new ideas. Whenever we have a sense of
resting on our laurels, one of the staff members inspires us to re-focus.
It is a great team, environment, and culture.”
What is in store for C5E? More change. They transition to
intermediate care (IMC) status by November. Currently, the staff
members are attending the Critical Care course and all of the nurses
are becoming ACLS certified. The nurses and techs from C5E are
shadowing nurses and techs in the Surgical IMC to learn from their
colleagues. The team also has plans to spend time in the OR observing
vascular cases so they have a thorough understanding of the
continuum for their patients.
Rajabrata Sarkar, MD, PhD, chief of vascular surgery, said,
“The nurses on C5E have made significant progress in caring for our
patients. I find the nursing staff friendly, responsive and always willing
to assist when I am on the unit. We look forward to continuing our
collaborative work and efforts focused on education and training
with the same positive spirit.” He and Robert Crawford, MD, Maureen
Shirflett, CRNP, and Kristy Gorman, MS, RN, OCN, Clinical Practice &
Education Specialist offered 16 hours of classes to educate the C5E
staff members about vascular surgery when they moved from 3D.
Now, as C5E transitions to an IMC, we will once again count on our
colleagues for further education.
The nurses have also remembered to educate new staff, as
part of their onboarding to the unit. Recently, Virginia just taught a
follow-up vascular class to staff members who joined the unit over
the past year. Susan Sims, RN, Clinical Nurse II, said, “The vascular
class taught by Virginia was informative and she did a great job. I’ve
been here for just a little over a year now, after my previous nursing
position at another hospital for 19 years, and I’m so happy with my
decision to come here. I’ve been impressed with UMMC and this
wonderful unit; the nurses are great and we have a constant learning
environment.” Susan has a wealth of experience in teaching cardiac
care, arrhythmias, and ACLS, and in addition to caring for patients, she
performs annual competency assessments in reading and interpreting
EKGs for the unit. Informally, Virginia leaves weekly rhythm strips at
the nurses’ station for nurses to independently assess themselves. If
they would like remediation, Susan makes herself available.
It is easy to encounter a positive spirit throughout C5E.
Anthony Barksdale, unit secretary, greeted me with a warm C2X
kind of welcome when I entered the unit. He has been on the C5E for
four years. Prior to working in Patient Care Services, Anthony was in
Housekeeping.
Pauline Amaechi, patient care technician, just started working
on the unit in March. “I like being a tech, I like the unit and I like the
work,” said Pauline.
Roslyn Mack, patient care tech, has been on the unit for three
years. She said, “I like the staff and teamwork.”
Cindy Schmigel, OTR/L, is a traveling occupational therapist.
“UMMC is one of the best places I’ve ever worked. The hospital is
clean, the staff have great rapport with the patients, the physicians
get back to you almost immediately, and the Intranet resources are
excellent. It is definitely a great place to be and really different, and
much better than other places I’ve work as a staff member or traveler,”
said Cindy.
While rounding on the unit, I visited with a patient and his family
member. The patient said “I’m retired police and a cynical person. I
had reservations about having my surgery here. I need to tell you, this
unit has a group of people here who care about what they do.
continued on page 21.
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you&ummc:
Welcoming New Nurses
to the UMMC Family
Martha Lefferts, BSN, RN, Clinical Nurse II, Neonatal Intensive Care Unit
Rachel Hercenberg, BA, Project Specialist, Clinical Practice & Professional Development
At UMMC, our coworkers feel like family. The
Medical Center offers a unique culture of support and
encouragement, as we work together to deliver the highest
level of care to our patients. There is a special bond and a
unique experience that all UMMC badge-wearers share;
who else gets to cheer in the hallways for a complete
stranger’s cancer recovery when they hear the bell rung
in the Department of Radiation Oncology, reference The
Great Cookie as a landmark when giving directions to
visitors, or see professional football and baseball stadiums
when looking out the windows of the hospital?
While we continue to create positive relationships with co-workers
and colleagues, it is important that we make our newest employees
feel welcome as part of the UMMC team. Turnover rates for nurses
within two years of hire at the Medical Center have continued to
increase in recent years, suggesting the need for a new onboarding
strategy. Under the direction of Lisa Rowen, DNSc, RN, FAAN, Senior
Vice President and Chief Nursing Officer, Nursing and Patient Care
Services, a small group of nurses and Clinical Practice & Professional
Development staff were commissioned to develop an “innovative and
effective onboarding strategy” for new nurses as part of the FY’13
Nursing Strategic Plan.
In an effort to engage new nurses as they transition
professionally to their role at the Medical Center, as well as transition
socially to the city of Baltimore, a new program was formed called
“you&ummc.” The “you&ummc” team, led by Martha Lefferts,
BSN, RN, Clinical Nurse II, Neonatal Intensive Care Unit and Rachel
Hercenberg, BA, Project Specialist, Clinical Practice & Professional
Development, created a comprehensive website that both new
and existing staff will find useful. This website offers a number
of resources for staff that includes housing and roommates, city
neighborhoods, UMMC culture and involvement, recreational
activities, transportation, childcare, and much more. This reservoir of
information can be useful to all members of the UMMC community.
New nurses will be introduced to this website when they
receive their offer letter, providing them with an early opportunity
to acclimate to the Medical Center and the Baltimore community.
In celebration of Nurses Week, the “you&ummc” team is proud to
introduce youandummc.org, which we hope will serve our newest
nurses as they transition to their instrumental role as a member of
our Medical Center family.
Left to right: Derek Eckenrode, Martha Lefferts, John Volcy,
Rachel Hercenberg, Cyndy Ronald, Justin Graves
11
12
Spring 2013
Nurses
Week 2013
N u r s e s t r ans fo r m i n g ca r e :
Wo r k i n g to g e t h e r to e m p ow e r ,
i nn ovat e and l e ad
Kick-off Event— Trends in
Nursing Practice Conference –
Ethics in Healthcare:
Making the Just Decision
This event featured a keynote address by a nationally recognized
speaker, in addition to presentations by our own chief nursing
officer and chief medical officer along with other UMMC
employees. The conference was well attended and received
very positive reviews.
Support Staff Salute Day and Team Celebrations
Unit based activities to celebrate the contributions made by
nursing support staff that provide quality patient care.
Nursing Excellence Awards
This ceremony recognized the special achievement recipients and
living excellence award selections. The award program was held
in the UMSON auditorium to allow for greater attendance. The
full program with the listing of all winners is located on the
UMMC intranet under the nursing tab at the following address:
http://intra.umm.edu/ummc/nursing/index.htm
Clinical Practice Summit
This two day long summit highlighted how nurses contribute to
excellence in practice. Over 55 posters were received, and rounds
were conducted on 17 of the posters. Submissions for “My UMMC
Nurse” were on display at the summit.
Clinical Practice Summit
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Candy Cart Rounding
This was a special salute to night shift with candy
carts visiting all patient care units between 9 p.m. and 11 p.m.
Nursing Staff Breakfast
A sumptuous breakfast served from 6 a.m. to 9 a.m. to the
nursing staff by the leadership team.
Nursing Grand Rounds
Topic: Work—Life Balance
3rd Annual Community Health Fair
The community health fair at Lexington Market was staffed by
UMMC employees who contributed 525 total hours to provide
support. It is estimated that over 1000 members of the community
attended the fair that consisted of 31 tables of health related
topics, along with blood pressure, BMI, and weight measurements.
Coffee Bar
Complimentary coffee, tea, and bagels were provided from 6:30
a.m. to 8:30 a.m. for those working on Saturday.
“My UMMC Nurse Is A Hero”
This was the first year for this type of recognition.
Submissions were received from family members and friends of
UMMC nurses to describe why “my nurse is a hero.”
Just a sampling —
“ ... Seeing the passion and love she takes
every day with her to work makes me feel
blessed...”
“ ... When she tells me about her work ...
she lights up. She glows when she talks
about her patients. Your hospital is
blessed to have her on staff!”
“ ... He does special things for people
without realizing how much the act will
impact the person’s life.”
“ ... Being a nurse is truly the calling God
has for her. I enjoy working at her side.
She is one of your top ten nurses.”
“ ... My stepmom can make a difference
in someone’s life in her job as an ER
nurse. She is a hero by accomplishing
the goal of giving many people a second
chance at life.”
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Spring 2013
We Discover
Journal Club:
Repeated Scenario
Simulation to
Improve Nursing
Competency
Xiaobo Hu, BSN, RN, CCRN-CSC, Senior Clinical
Nurse I, Cardiac Surgery Intensive Care Unit
Pat Woltz, MS, RN, Director of Nursing Research
About 30 nurses were present for the
March 2013 journal club that was
facilitated by Xiaobo Hu, BSN, RN,
CCRN-CSC, Senior Clinical Nurse I,
Cardiac Surgery Intensive Care Unit,
who reviewed a study by Abe, Kawahara,
Yamashina, and Tsuboi (2013). The study
evaluated the use of simulation training
as an educational approach to develop
clinical competencies in nurses that require
critical thinking skills. Demands such as a
rapidly aging society, advances in medical
science and technology, and the focus on
healthcare quality and safety have resulted
in an increasing gap between traditional
nursing education and the advanced critical
thinking skills needed by competent critical
care nurses.1 Simulation based education
provides hands on experiences and allows
for easy verification of learning outcomes
based on nurses’ actions.
The study used a quasi-experimental
time-series crossover design to evaluate
the effectiveness of repeated scenario
simulation training among 24 Japanese
nurses at the Tokyo Medical University
Hospital. Study outcomes were selfassessed nurse competency and perception
of teamwork and non-technical skill. All
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nurses received six months of didactic
training on cardiovascular critical care
nursing and were divided into four groups
for simulation training in four zones. Each
group rotated through the four zones,
where the order of the scenarios in each
zone was randomly determined. In each
zone, scenarios were repeated once and
debriefing occurred during and after each
scenario. Half the group participated in
a scenario, followed by the second half of
the group as the scenario was repeated.
After each scenario, participants scored
their own performance using a rubric.
Participants also scored teamwork and nontechnical skill using the Teamwork Activity
Inventory in Nursing Scale (TAINS).2
Results showed that regardless of the
order in which groups, or the participants
within a group, progressed through the
various scenarios, all competency scores
increased: 1) after the second simulation
in a zone; and 2) as repetitions increased
across zones. The TAINS survey showed
significant improvement in three out of
six subscale scores for “Job Satisfaction,”
“Confidence as a Team Member,” and
“Attitudes of the Superior” (all p’s <.05).
The authors concluded that repeated
scenario simulation enhanced individual
nurses’ technical skill (competency) and
somewhat improved their teamwork
and non-technical skills. The authors
acknowledged that small sample size, single
site, and bias due to the voluntary nature of
the participants were study limitations.
Group discussion:
◗◗ The group agreed that this study
supported previous research and
simulation training among Japanese
critical care nurses. Findings that
simulation improved nurses’ nontechnical skills, including job satisfaction,
are of particular interest. Larger, multiinstitutional studies are recommended
with a control group to compare didactic
only to didactic plus simulation training.
◗◗ UMMC is a large academic institution
with many staff, a relatively quick
turnover, and different nurse experience
levels coupled with cutting-edge
technology and a complex patient case
mix. Thus, staff education and clinical
competency validation is an important
part of practice. Simulation based
education as an evidence-based practice
for competency and critical thinking
skill acquisition seems underutilized for
nurses at UMMC.
◗◗ The implications of the study were
highlighted by the introduction
of Maryland Advanced Simulation
Technology, Research & Innovation
(MASTRI) Center’s Training & Curriculum
Specialist and Clinical Educator, Sheree
Chase, MSN/MBA, RN. Sheree answered
questions about the use of scenariobased simulation in the MASTRI Center,
which is located on the 7th floor of South
Hospital building, and how to better
use MASTRI Center resources for nurse
competency training.
1
Abe, Y., Kawahara, C., Yamashina, A. & Tsuboi, R.
(2013). Repeated scenario simulation to improve
competency in critical care: A new approach for
nursing education. American Journal of Critical Care,
22(1), 33-40.
2
Takayama, M. & Takeo, K. (2009). Structure of
teamwork and relevant factors in nursing activities.
Journal of Nurse Studies NCNJ, 8, 1-9.
online at http://www.umm.edu/nursing/newsletter.htm
on the UMM Intranet at intra.umm.edu/ummc/nursing-dept/newsviews.htm
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Certification
Corner
Becoming a
Certified Medical
Surgical Nurse
Tonnette Branch, RN, CMSRN, Senior Clinical
Nurse I, Charge Nurse, 13 East/West Medical
Telemetry Unit
In July of 2012, I became a Certified
Medical Surgical Nurse – and in the process,
I became a better nurse.
My nurse manager and senior nurses
on my unit encouraged me to pursue
certification. At first, I was reluctant. I had
been out of school since 1993 and was very
anxious about taking another major exam.
After much thought and with my
patients in mind, I realized that knowledge
was power – the kind of power that I could
use to be the best nurse I could be. So, I set
out for the task at hand. I was told about the
Medical-Surgical certification, which I found
to be aligned with my patient population.
In October of 2011, several co-workers and I
enrolled in the medical surgical consortium
review course. Over the 3-day review course
I kept thinking to myself, “Can I do this?” and
reminding myself that the last major exam I had
taken was the NCLEX 18 years ago.
As I listened to the lecture, I realized
how much I had forgotten, but was excited
to fill my head with old and new knowledge.
After completing the review course, my
next step was to schedule a test date. Since
I was anxious about the exam, I scheduled
myself for the last possible date. I remember
studying and thinking, “How am I going
to pass this?” It felt like I was back in
nursing school. On the day of the test I was
encouraged and nervous. I froze with the
first question and felt like I had forgotten
everything I had studied. I answered the
questions to the best of my ability.
Down to the wire, 20 questions and 20
minutes before the computer was scheduled
to shut off. Once I completed question
#150 and pressed the end button, I got an
immediate score “Passed.” I was in disbelief,
yet excited, and proud of myself for what I
had accomplished.
As a professional nurse, my goal is to
be the best nurse I can be. I feel that being
a Certified Medical-Surgical Nurse helps me
to achieve that goal. To this day, I continually
reference my notes and have shared study
materials with my colleagues.
Now as a certified nurse, I encourage
my fellow RNs to pursue this as a professional
goal. Eligibility for this certification through
the Medical-Surgical Nursing Certification
Board requires two years of nursing
experience. On my unit, prior to the two year
mark, nurses are encouraged and assisted
to enroll in the review course. My unit has
ten RNs who are certified and several in
the test-taking process. For me, it is a great
accomplishment, and I feel a sense of pride
knowing that my patients will benefit from
the knowledge I’ve gained.
Boston Marathon Nurse continued from page 1.
wide range of issues. Exercise-associated collapse, hypothermia, and
dilutional hyponatremia are among the ailments that we frequently see.
At 2:50 p.m., I heard a blast not unlike the mock cannons that
are fired every Sunday from Fort McHenry. Whispers floated through
the staff in the tent. Could the sound that we heard be celebratory
cannons? It was Patriots Day, after all. Shortly after, I heard another
blast. I walked over to one of the physicians, who voiced the thought
in the back of my head — that it could have been a bomb.
Boston EMS personnel had been stationed in the respiratory
care section of the tent, and all of their radios went off simultaneously.
Some of them sprinted out of the tent while others stayed and
frantically prepared their equipment. I knew something had to be
seriously wrong. I looked over to the television and saw the blast
being covered live. I immediately took out my phone to call my mom.
When she picked up, I quickly told her, “I am safe. There are bombs
in Boston, but I am safe.” I sent a text to my girlfriend saying, “I am
safe.” After that moment, the phone traffic went dead. No one in the
tent could get calls out.
I discharged as many runners as I could from the tent. I told
them that if they could walk, they should get out.
The first victim to come into the tent was an image I would
never forget: a young man was wheeled in with both of his legs
amputated by the blast. He was awake and had mere strands
of flesh hanging down from both of his legs. It was surreal. The
patients started rushing in, filling every corner of the tent. All ages
were present among the victims. It was mass pandemonium. Triage
sections were set up in the tent so that the victims with more severe
injuries would be transported first. A subsection of the tent was
assigned as the morgue.
I snapped into gear. I had the training, and now I just had to use
it. I walked up to one of the victims awaiting transport. He already
had tourniquets on both of his leg amputations, and the bleeding
was controlled. I started an IV and hung fluids. But what else could I
do for this man? He needed surgery, and we could not do that in the
tent. There were four other doctors and nurses around his stretcher, so I
stepped back for a moment to collect my thoughts. Could this be real?
Or was this just a horrible nightmare that I would surface from soon?
A physical therapist in tears approached me. She was extremely
upset that none of the runners were being treated for their injuries. I
quickly eyeballed the remaining runners in the tent to make sure they
had no life-threatening injuries.
I then moved over to the level three section of the tent. I found
an adolescent girl and her mother who each sustained injuries to both
legs. The girl was panicking that she would lose her legs. I reassured
her. I started caring for the girl and her mother. I put in IVs, reviewed
their injuries, and splinted their legs for transport. I even started
taking a blood pressure on the mother, when I soon realized that the
number is meaningless in the chaos of a mass-casualty incident.
About 25 minutes after the blast, we had all 97 of the blast
victims who came through our tent transported to hospitals. We
transferred the remaining runners to Medical Tent B. Shortly after, the
police moved us out of the tent and sectioned the road off as a crime
scene. I heard another bomb go off, but was reassured by another
volunteer that it was a controlled detonation by Boston police.
This tragedy, for me, was a major reality check. It emphasized
for me the importance of family, friends, and — most importantly —
LIFE. My heart goes out to the families and the victims of the Boston
Marathon bombing. That said, without such a well-trained, organized
and dedicated group of first responders that day, there would have
been more casualties. The medical professionals in Medical Tent A,
Boston EMS, Boston Police, and a countless number of bystanders
saved many lives that day. I am proud to have worked among such a
great group of people. I am proud to be a Boston Marathon Nurse.
15
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Spring 2013
Improving Pain Management
– Strategies that Work
Karen Snow Kaiser, PhD, RN, Clinical Practice Coordinator,
Division of Quality and Safety
Consumer satisfaction ratings are used nationally as one method
to stimulate healthcare quality improvements. The Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS) survey is
one of the tools developed to support this initiative.
Randomly selected discharged patients are asked to respond to
standardized HCAHPS questions about their hospital experience
by a nonpartisan group. Survey results are then reported nationally,
so patients can compare hospitals (see Hospital Compare website
www.hospitalcompare.hhs.gov).
UMMC has identified a goal to perform better than the 55th
percentile on the nationally reported HCAHPS pain subscale in the
FY’13 annual operating plan. This goal is important because our
HCAHPS pain survey items consistently show moderate to strong
relationships between patients’ overall satisfaction ratings of UMMC
and their likeliness to recommend UMMC to others. Performance on the
HCAHPS pain subscale is also an important measure of improvement
for our Magnet redesignation. For that measure, we must demonstrate
higher than average performance (greater than the 50th percentile)
for five out of the previous eight quarters. Currently our HCAPHS pain
subscale is at 74.4%, slightly greater than the 55th percentile. However,
we have only exceeded the 50th percentile, which is currently 73.8%,
three times over the last eight quarters, resulting in an opportunity for
improvement.
To improve the HCAHPS pain subscale, we need to improve the
scores on the two survey items that comprise the subscale. These
items assess how often staff did all that they could to manage pain and
whether or not pain was well controlled. The UMMC Pain Committee
and Pain Task Force have been looking at ways to improve our
performance on these measures. They identified our high-performing
units (units with HCAHPS pain subscale scores higher than the 50th
percentile). These units demonstrate at least two of the following
characteristics.
◗◗ Pain Task Force members routinely attend meetings.
◗◗ Nursing leadership and/or a pain champion is highly engaged and
ensures pain is a priority at the unit level.
◗◗ A unit level improvement group is focused on improving
satisfaction, including special efforts targeted at improving pain
management.
A variety of activities have been used by the high-performing units to
improve their HCAHPS pain satisfaction scores. Since pain is a complex
interdisciplinary issue, most have deployed more than one strategy.
Some of the frequently used strategies are:
◗◗ An enhanced focus on pain during hourly rounds and/or handoffs.
◗◗ Noting ‘prn’ analgesic medication administration times on patient
white boards.
◗◗ Using patient huddles to modify the pain management plan for
patients with high pain scores.
◗◗ Encouraging pain patient education video use.
◗◗ Advocating for patients with other health care professionals.
◗◗ Sharing HCAHPS pain data and patient reported pain
experiences (HCAHPS’s Voice of the Patient or patient letters)
weekly or bi-weekly.
The Medical Center’s HCAHPS data support using many of these
strategies. There are several relationships between other non-pain
HCAHPS survey items and the pain HCAHPS items. For example, nurses
listening carefully, clear communication by nurses, courtesy and respect
by nurses, patient advocacy, teamwork, and perceptions about receiving
the proper care all have moderate to strong relationships to the HCAHPS
pain survey items. This suggests that focusing on related survey items,
many of which are part of our rounding and handoff initiatives, may also
improve the HCAHPS pain items. Specifically, the following may improve
the HCAHPS pain survey item scores and the management of our
patient’s pain by paying special attention to the following:
◗◗ Being courteous and respectful of a patient’s reports of pain.
◗◗ Listening carefully about a patient’s pain concerns.
◗◗ Acting as a patient advocate for pain issues.
◗◗ Encouraging teamwork when developing or modifying a pain
management plan.
◗◗ Clearly communicating the pain management plan to the patient.
The high-performing units note that constant vigilance is required
for them to continue to outperform the national scores on the HCAHPS
pain items. There tends to be little variability in HCAHPS scores for
those with scores in the “middle of the pack.” Small changes in scores
may result in large shifts in percentile rank between quarters. We know
that changes in clinical processes improvement take time to become
routine, so we can be lulled into thinking that short term gains are
permanent and slip back into old practices. Since hospitals are striving
to improve their nationally reported HCAHPS scores, the target keeps
shifting, with this year’s pain subscale 50th percentile increasing
almost a full point over last year’s score. Therefore, becoming and
staying a top performer requires constant attention to pain and the
strategies used to improve its management.
Another issue is that fluctuation in scores occurs by chance. The
small amount of variability in the “middle of the pack” means that even
by “doing nothing” we may appear to improve. These misleading gains
are short lived and scores slip backwards. The “bouncing up and down”
improvement in some quarters and declining in others can point to
unstable variable clinical processes. Bouncing can lead to a false sense
of security and a belief that we don’t need to address the issue. This is
a reason why Magnet requires several quarters of demonstrating higher
than average performance on several HCAHPS subscales. This helps
delineate better performers, and those who are actively striving to
improve performance.
Based on the experiences of high performing units and
an informal assessment of barriers to providing effective pain
management, the Nursing Process Improvement Council and Pain
Task Force members are working together to make pain management
more visible and actionable on the units. They are leading the effort to
incorporate the following into their unit activities:
◗◗ Increasing the focus on pain during hourly, shift change, and
multi-disciplinary rounds.
◗◗ Incorporating the patient’s pain goal, time the last ‘prn’ analgesic
was administered and/or time next dose is available into the pain
care plan, the kardex, the plan of care or the white board.
◗◗ Using huddles to plan a modification of the patient’s pain
management plan for patients with uncontrolled pain.
◗◗ Using the kardex, the plan of care, and end of shift reports to
share “what works” for individual patients.
continued on page 18.
news
&views
Nurse Practitioners in the Neonatal ICU…
Caring For Our Smallest Patients
Jennifer Fitzgerald, MS, NNP-BC, Lead NP, Neonatal Intensive Care Unit NP Team
It is often difficult to find the right words to sum up the role of the nurse practitioners in the Neonatal Intensive Care
Unit (NICU). As a neonatal nurse practitioner (NNP), the population of patients we have chosen to care for is, in the
world of advanced practice nursing (APN), a very narrow field. The NNP is recognized by the National Organization for
Nurse Practitioner Faculties (NONPF) as an acute care nurse practitioner (ACNP) with an educational focus in caring for
neonates with acute, critical, or chronic illnesses.
People often think of the NICU as the “preemie nursery” when, in fact,
premature infants are only a portion of the patients for whom we
provide care. Although the tiniest and most prevalent of our patients
are born prematurely, the NNP cares for any newborn with illnesses
that impact the ability to successfully transition to life outside the
womb. Our focus is to care for the infant within the dynamic of the
family and encourage the tools which make parents and other family
members knowledgeable and confident caregivers when their infant is
stable for discharge.
The history of neonatal nurse practitioners in Maryland began
at the University of Maryland Medical Center in 1979, with the
employment of the State’s first NNP. Our team of neonatal nurse
practitioners continues to grow and is currently a team of thirteen
NNPs. Several years ago, we began a program to support RNs within
our unit who were interested in becoming NNPs. In May 2013, the
first two RNs from this program graduated and joined our NNP team,
proudly continuing the legacy started at UMMC.
As in all other areas of the Medical Center, medical advances
and changing team dynamics require evaluation of the processes that
impact care of the neonates in our unit. There are several areas where
our NNP team impacts our NICU and the division of neonatology.
Our NNPs are involved in resident, staff, and community education.
The NICU seems to be a world of its own and can be overwhelming
for interns who are expected to perform upon arrival to our unit.
Every month, one of our NNPs participates in orienting the incoming
interns to the NICU and our unique environment. Our nursing and
resident team members benefit from NICU cards that were developed
as part of a multi-disciplinary team to communicate basic medical
information and care guidelines. The continued production of these
cards is maintained by one of our NNP team members, Pam Ansalvish,
MS, NNP-BC. Several other NNP team members have participated in
the development of a neonatology handbook of care to be published
for the incoming July 2013 pediatric intern class.
A process improvement project to improve the admission
temperatures of our most premature infants has led to dramatic
improvement in these infants. The maintenance of a neutral thermal
environment takes a team effort and the involvement of Anita Macek,
MS, NNP-BC, as an integral member of that team.
One of the hardest parts of our job in the NICU is helping
families cope with devastating outcomes and end of life care.
Pediatric palliative care is an aspect of our job that is not always
comfortable, but it is essential to ensure that we are providing
compassionate care to our patients and their families. We are lucky
enough to have some very special providers in the NICU who are able
to compassionately and effectively work with our families. Two of our
NNPs are planning to pursue a certification in palliative care during
the next year and a half.
Several of the Medical Center’s NNPs should be recognized in
this article, however it takes the entire group working together to
make the team so effective. The NNP team consists of the following
members: Pam Ansalvish, MS, NNP-BC, Vikki Beltran, MS, NNP-BC,
Nikki Brandon, MS, NNP-BC, Cecil Daly, MS, NNP-BC, Jenny Dukes,
MS, NNP-BC, Myreda Erickson-O’Brien, MS, NNP-BC, Anita Macek,
MS, NNP-BC, Krisitin McCullough, MS, NNP-BC, Linda Moses, MS,
NNP-BC, Chrissy Mulford, MS, NNP-BC, Darbi Robinson, DNP, NNPBC, and Natalie Terrell, MS, NNP-BC. Additionally, there are two
University of Maryland School of Nursing faculty members on staff
with us, Dawn Mueller-Burke, PhD, NNP-BC and Susan Braid, DPH,
NNP-BC. In addition to Darbi Robinson, DNP, NNP-BC, the liaison we
have with the school of nursing gives our team leadership potential
for future research opportunities.
As the lead for this talented team of professionals that
consistently provide compassionate, expert neonatal care, I would like
to express my thanks publically for their hard work and dedication.
17
18
Spring 2013
Nursing Governance Restructure
Vascular Surgery Progressive Care Unit Restructures Committees
Visitacion “Bing” Casal, BSN, RN, Senior Clinical Nurse I
Noel Corpus, BSN, RN, Senior Clinical Nurse I
Virginia Nganga, BSN, RN, Senior Clinical Nurse I
Simone Odwin-Jenkins, MBA, BSN, RN, Nurse Manager
Victoria Phelps, BSN, RN-BC, Senior Clinical Nurse I
Vascular Surgery Progressive Care Unit
The Vascular Surgery Progressive Care Unit (VSPCU) staff,
under the leadership of Simone Odwin-Jenkins, MBA,
BSN, RN, nurse manager, are constantly looking for ways
to improve patient care through employee engagement and
patient satisfaction. To that end, we recently restructured all
the committees into four major unit committees.
1.
2.
3.
4.
Clinical Practice Committee
Quality & Safety Committee
Education Committee
Commitment to Excellence (C2X) Committee.
Every staff member is expected to be a member of a committee,
and this includes nurses, PCTs, and unit secretaries. Prior to staff
selection or voting, the senior clinical nurses on the unit campaigned
and introduced their committees to the staff during our November
2012 staff meeting. The role of the senior clinical nurses was to act as
facilitators on these unit committees. After the campaign, staff were
given two weeks to decide which committee they wanted to join and
were assigned to committees based on their choices and on the need
for role balance within a committee.
To make the transition more meaningful to the staff and to
solicit better engagement, each staff member was asked to pick two
top choices of a committee on which to serve, and/or send an e-mail
to a manager. After the results were reviewed by the manager, each
staff member was assigned to a specific committee and contacted by
that committee’s facilitator. Each committee had a kick-off meeting
and elected officers. Newly hired staff have three months to choose a
committee. The following is a summary of the projects and activities
implemented by each committee since January 2013.
Clinical Practice
◗◗ Complete bedside shift handoff went live on March 4, 2013. The
incoming and outgoing charge nurse, bedside nurse, and PCT
participate in a full shift report at the bedside and include the
patient.
◗◗ A mobility task force has been created to assist in the mobilization
of our patients.
◗◗ The committee is encouraging all nurses to pursue medical-surgical
certification.
Quality and Safety Committee
◗◗ Ensures that the unit committee’s goals align with the UMMC FY ’13
Nursing & Patient Care Services strategic priorities.
◗◗ Representatives from the group attend the monthly hospital-wide
committees for falls, skin care, pain, and process improvement.
◗◗ The group is creating the quality and safety data board that
displays the latest data for pressure ulcers, CLABSI, CAUTI, falls,
hand hygiene, pain, and MIDAS documentation.
Education Committee
◗◗ A journal club was created and is held monthly to discuss relevant
articles from a reputable nursing journal.
◗◗ Bi-weekly education sessions are held every other Monday.
◗◗ A core curriculum in vascular surgery was implemented for all
nurses.
◗◗ An annual EKG/telemetry competency was developed.
Commitment to Excellence (C2X) Committee
◗◗ The employee recognition board has been installed.
◗◗ The C2X events board was mounted inside the staff lounge to
acknowledge monthly birthdays, advertise staff events, and
highlight the employee of the month.
◗◗ Currently working on strategies to improve patient satisfaction.
Since the unit restructured all of the committees, the leadership
team has noticed increased staff engagement in unit operations and
involvement in decision making. There has been improved interaction
with our medical staff colleagues and each other. We are proud of
the work that has been done thus far, and we look forward to the
continued success of the unit.
Pain Management continued from page 16.
The Patient Education Council and the Pain Task Force are also
encouraging the use of the pain related patient education videos.
This strategy has improved our HCAHPS scores in the past. The
videos address issues that have been shown to be patient barriers to
adequate pain management. The videos help patients understand:
◗◗ Their right to pain management.
◗◗ The benefits of adequate pain management.
◗◗ The importance of pain assessment, including the use of
pain scales.
◗◗ Their role in pain management (e.g., reporting analgesic
side effects and uncontrolled pain).
◗◗ Different strategies available to manage pain.
◗◗ Realistic expectations.
Some of the strategies outlined above may appear to take an
additional amount of nursing time. However, nurses report these
strategies save time by reducing call light use and improving patients’
ability to perform their activities of daily living and adherence to
treatments, such as physical therapy. These strategies also support
UMMC’s patient-centered care model. Please help UMMC to obtain
HCAHPS goals by joining with your unit’s Pain Task Force, the Nursing
Process Improvement Council, and your Patient Education Council
representatives in these initiatives to more effectively manage your
patient’s pain.
news
&views
Spotlight
on Pharmacy
A Prescription
for Teamwork
Nakia Eldridge, PharmD,
Women’s and Children’s Pharmacy Manager
Christina Cafeo, DNP, RN, Director,
Medical and Surgical Nursing
Jennifer Servary, MBA,
Performance Improvement Leader
The Medication Process Improvement
(MPI) Committee, under the leadership
of Christina Cafeo, DNP, RN, Director,
Medical and Surgical Nursing and
Nakia Eldridge, PharmD, Women’s
and Children’s Pharmacy Manager is
a committee charged with addressing
opportunities for improvements in the
medication use process. A targeted area was
missing medications – those medications
that should be on the unit but cannot be
located. The committee partnered with the
Center for Performance Innovation to get a
new perspective on this old problem.
With the help of Jennifer Servary,
MBA, Performance Improvement Leader,
the MPI co-chairs agreed to target missing
doses using a “Lean” approach. Lean is a
systematic approach to problem solving
that focuses on eliminating or minimizing
waste in a process. For 2012, the committee
reviewed and identified units with high
missing-dose requests per month. The units
were: Transplant IMC (Gud 8), Cardiac
Surgery Intensive Care Unit (Gud 6), and
Medicine Telemetry (11 East).
Nursing representatives were recruited
from each unit. They were Dana Rojek,
BSN, RN, Clinical Nurse II and Nathan
Shapiro-Shellaby, BSN, RN, Clinical
Nurse II, Cardiac Surgery Intensive Care
Unit; Jessica Dolim, BSN, RN, Clinical
Nurse II, Transplant; and Mandy Chavez,
BSN, RN, ACRN, Clinical Nurse II, 11
East. The pharmacy representatives were
Mohammed Sarg, PharmD, Neelesh
Vaiyda, PharmD, and Marisol De Leon,
PharmD. The goal of the group was to
recommend initiatives or experiments to
decrease the missing dose requests in pilot
areas by 50%.
First, the group sought to understand
the current process and potential barriers
in reaching their targets by conducting
observations through shadowing. The
nurses accompanied the pharmacists and
were able to identify some pharmacy
barriers, like distractions during the
dispensing process. The pharmacists
accompanied the nurses and were able
to identify some nursing barriers, like
multiple medication locations. Once the
group understood the gaps and barriers
in the current process, they were able to
brainstorm methods for improvement or
“experiments.” The group initially had
more than ten experiments. These were
prioritized to three for the first phase of
the project.
Experiment #1: Create flow and
organization in the medication rooms.
The group used the “Six Sigma” (6S)
method in each unit’s medication rooms.
The 6S method is a six-step process:
(1) sort; (2) set in order; (3) scrub; (4) make
safe; (5) standardize; and (6) sustain. The
event included the nurse manager, MPI
team members, and unit staff. The group
removed excess items from the medication
rooms, created a specific location for the
items needed, and labeled each drawer
and cabinet. These changes established
a clean environment and cues for visual
management of the work area.
Experiment #2: Decrease storage locations.
The group moved all medication storage
areas to the medication room. By placing
the medication storage locations in one
area, the amount of searching and walking
that nurses performed on a daily basis was
reduced. Also, centralizing the location of
all medications assists in the future phases
of the project when the group attempts
to identify other barriers to finding
medications.
Experiment #3: Reconfigure the Omnicell®
The current philosophy is to store
emergent, non-scheduled, and controlled
substances in the Omnicell®. The MPI
group agreed that missing medication
requests would decrease if the most
frequently used medications were
available on the unit. For this experiment,
medications with low use were removed,
pars were modified, and medications with
high use were added to the Omnicells® in
the pilot areas.
Over the last several months, the
MPI team of nurses and pharmacists
have brainstormed, implemented, and
monitored the three experiments with the
support of the MPI steering team. The
steering team includes Mary Taylor, MS,
RN, Director, Women’s and Children’s;
Jonathan Gottlieb, MD, Senior Vice
President and Chief Medical Officer;
Agnes Ann Feemster, PharmD, Interim
Director, Pharmacy; Barbara Brannan,
PharmD, Pharmacy Safety Officer;
C. Bret Elam, Pharmacy Practice Manager;
and Bethany Shelbourne, PharmD. This
group is committed to providing the team
with the resources and support needed
to achieve the goal of decreasing missing
medication requests.
Throughout the project, the
pharmacy and nursing team members
discovered a more respectful, appreciative,
and trusting relationship. Each member
invested time and energy to collect
information from other frontline staff
members and to understand the root cause
of issues in both pharmacy and nursing.
Both disciplines worked collaboratively to
ensure an effective and efficient medication
process. The bonds created during this
project will stay for a long time after the
project is completed and will hopefully
spread beyond the three units piloted.
19
20
Spring 2013
Improving Patient Family-Centered Care The Proof is in the Outcomes
Gena Stiver Stanek, MS, RN, CNS-BC, Clinical Nurse Specialist, R Adams Cowley Shock Trauma Center
The R Adams Cowley Shock Trauma Center (STC) Patient Family-Centered Care Council (PFCC)
has been on a journey to improve patient family-centered care over the last several years. This
interdisciplinary council, including family members, was chaired by the following nurses:
Katherine Mulligan Vann, BS, RN, Senior Clinical Nurse II and Amira Lawrence, BS, RN, Senior
Clinical Nurse I. The current chairperson is Karen Memphis, BS, RN, Senior Clinical Nurse I.
Gena Stiver Stanek, MS, RN, CNS-BC, Clinical Nurse Specialist and Lynn Armstrong, BSN, RN,
Nurse Manager, serve as mentors.
The work of this council began
in early 2009, after reviewing
the evidence, brainstorming
priority-improvement areas,
and conducting a STC wide
survey using the Institute
for Patient Family-Centered
Care assessment tool entitled,
“Are Families Considered
Visitors in our Hospital or
Unit?” The survey included all
staff, as well as patients and
families. In addition, a brief survey was done to determine how nurses
perceived expanding visitation. The data was analyzed and areas
for improvements were prioritized. In order to move the culture and
implement successful change, the council worked with Karen Doyle,
MBA, MS, RN, NEA-BC, Vice President of Nursing and Operations, STC
and Emergency Services, and the STC Coordinating Council. An allday kick-off retreat called, “Improving Patient Family-Centered Care”
was conducted to provide education to staff from all nursing units,
leadership, and the interdisciplinary team.
The results of the survey indicated several areas that needed our
focus: 1) flexibility with individualized visitation; 2) families welcome
24/7; and 3) family opportunity to share information and feel welcome
in discussions. The retreat agenda was geared to those focus areas with
topics on patient family-centered care and a panel of former patients
and families that provided feedback on what went well and what they
would change about their patient experience. In the afternoon, the
participants brainstormed about actions to be taken around the priority
improvement areas. These action items were implemented in 2010 and
are ongoing.
The 2012 post-survey results reflected dramatic improvements in
key areas, as summarized below:
◗◗ Nurses’ anxiety was reduced from 60% to 16%.
◗◗ Flexibility with individualized visiting increased from 0% to
80-90%.
◗◗ Families welcome 24/7 increased from 0% to 90%.
◗◗ Families welcome in discussions increased from 26% to 88%.
◗◗ Families able to share information increased from 8% to 92%.
This group will continue their important work by focusing on
implementing patient family-centered care bundles and improving
communication related to the plan of care.
Would you like to have your article
published in News&Views ?
Submitted articles should:
• Present clinical and professional nursing practice topics
in inpatient, procedural and ambulatory areas that are
evidence-based, innovative, and outcomes driven.
• Focus on divisional, departmental and/or organizational
strategic goals. See page 2 for submission guidelines.
news
&views
Rounding Report
continued from page 10.
After spending time with them, I will take these people to my grave
with me, that’s how much they mean to me. They went beyond
helping a fellow human being. I just can’t say enough.”
Cheryl-Ann Daley, MS, RN, Clinical Nurse II, has been on the
unit for two years. Cheryl-Ann, who previously earned a degree in
criminal justice, said, “I enjoy working with everybody on the unit. The
teamwork is great, the general attitude is positive, we have improved
patient outcomes in hand hygiene and falls, and we’ve implemented
some house-wide protocols. You want to be a part of a movement
that focuses on improving patient care. We also focus on recognizing
staff on the unit. We all work hard, moving together to accomplish
something.”
It’s true! The staff members of C5E have accomplished a lot!
“It has been a joy to watch the cultural transformation on the
Vascular Surgery PCU,” said Tina Cafeo, DNP, RN, Director, Medical
and Surgical Nursing. “When you walk onto the unit, staff are openly
friendly and engaging. They are innovative in their approach to
improve patient care processes, satisfaction, and safety. The staff
successfully made the transition from medical to surgical care
delivery. This was no small endeavor. They continually evaluate their
progress to set goals and formulate plans to improve outcomes. This
unit functions as a true professional environment. The staff engage in
continuous change, hold each other accountable, own their practice
and outcomes, and truly care for each other and their patients and
families. I am so proud to have them as part of my team at UMMC.”
It is rare to see a unit with this much energy and vibrancy, with
a penchant for improving patient care and continuing their own
professional development. If you had any doubt about the C5E staff
members’ enthusiasm for quality improvement and nursing care,
just watch the video “Hand Washing in the House Tonight.” Maybe
you were fortunate enough to catch it at one of the C2X Employee
Communication Forums? It was conceived of and written, directed
and produced by members of C5E. In the video, it is evident how C5E
staff members combine their love of singing, dancing and having fun
with engaging colleagues from other units across the Medical Center to
participate in this video about an important message for patient care.
For these reasons, C5E has been awarded the CNO Team Award
for Extraordinary Care for 2013. Please join me in congratulating them
and recognizing their excellence.
21
22
Spring 2013
Honorable
Mention
Professional
Advancement Model
Promotions
Laura Bothe, RN *
Congratulations to the following UMMC
nurses promoted in January and April 2013!
Emmylon Cui, BSN, RN
Melisha Spahr, RN, CCRN*
Multitrauma IMC
Interventional Radiology
Monica Chiduza, MSc, RN, CCRN
Francis Grissom, BSN, RN
Surgical ICU
Multitrauma ICU
Mercy Ejikemeh, MPH, RN, CMSRN
Surgical ICU
Senior Clinical Nurse I
Kelly Powers, RN*
Cardiac Prep & Recovery
Cherry Joy Rumbaoa, BSN, RN, CMSRN
Weinberg 5
Meghan Taneyhill, BSN, RN, PCCN
Cardiac Progressive Care
Nicole Fletcher, BSN, RN, CEN
Adult Emergency
Mary Caroline Weaver, MS, RN, CCRN
MICU
Catherine Dickel, RN, CNOR*
Shock Trauma OR
Darlene Gray-Silver, BSN, RN
Select Trauma IMC
EP Lab
Dominique Feldman, BSN, RN, CCRN
Medical ICU
Interventional Radiology
Lisa Petty, BSN, RN
Donna Walker, RN*
MPT/RRT
EP Lab
Rebecca Mary Gilmore, RN*
* Enrolled on a BSN and/or a MS program
and graduation by July 1, 2015.
TRU
Domonique Banks, MS, RN
Neuro ICU
Senior Clinical Nurse II
Carolyn Wirth, BSN, RN, CCRN
Christa Zagol, BSN, RN, CNOR
Select Trauma ICU
PICU
Jaclyn Bashmann, BSN, RN
Tracy Baca, BSN, RN, CCRN
Cath Lab
Emily Coleen Smith, BSN, RN, CCRN
Select Trauma ICU
Transitional Care Unit-C8
Cardiac Prep & Recovery
Note: Next advancement application cycle is July 1–15, 2013.
All applicants must have a conferred BSN or higher degree.
Shock Trauma
Nurses Present
Evidence-based
Practice Projects
Lynn Gerber Smith, MS, RN,
Senior Clinical Nurse II, Trauma Resuscitation Unit
Roy Ball, MS, CRNP, ACNP-BC, CCNS, Clinical
Nurse Specialist, Trauma Resuscitation Unit
Karen Doyle, MBA, MS, RN, NEA-BC,
Vice President of Nursing and Operations,
R Adams Cowley Shock Trauma Center
(STC) and Emergency Services, and newly
elected President of the Society of Trauma
Nurses, provided opening remarks at the
Society of Trauma Nurses 16th Annual
Conference in Las Vegas, NV in April
2013. The Society of Trauma Nurses is a
professional nonprofit organization whose
mission is to ensure optimal trauma care
to all people locally, regionally, nationally,
and globally through initiatives focused
on trauma nurses related to prevention,
education, and collaboration with other
GI Endoscopy
Jennifer Motley, BSN, RN, PCCN
Multitrauma IMC
Terri McMichael, BSN, RN
Cheron Hawkins, BSN, RN
Johnathan Klaus, RN*
Karen Doyle, Diana Clapp and Amanda Larsen
healthcare disciplines. Shock Trauma
staff and their academic efforts were well
represented at the conference. In addition
to the multiple presentations by STC
nurses, staff from the OR, PACU, and
Select Trauma were in attendance.
Kathryn Von Rueden, MS, RN,
FCCM, ACNS-BC, Clinical Nurse
Specialist, STC and Associate Professor
at the University of Maryland School of
Nursing, presented, “Burnout, Compassion
Fatigue, Secondary Traumatic Stress:
Buzzwords or Real Deal?” and “Rapid Fire
Countdown: Getting the Empathy Back:
Five Things You Can Do Right Now.”
Karen McQuillan, MS, RN, CCRN,
CNRN, FAAN, Clinical Nurse Specialist,
STC, presented, “International Nursing
Collaboration to Reduce Central-Line
Acquired Blood Stream Infections.” This
international collaboration between Shock
Trauma and Jai Prakash Narayan Apex
Trauma Center in New Delhi, India
focused on evidence-based best practices
for the reduction of catheter-related blood
stream infections. Karen received the award
for best overall abstract for her poster and
oral presentation.
continued on page 23.
Karen McQuillan
continued on page 0.
news
&views
The Past, Present,
and Future of
Trauma Nursing
Lynn Gerber Smith, MS, RN, Senior Clinical
Nurse II, Trauma Resuscitation Unit
The R Adams Cowley Shock Trauma
Center remains a very popular area of
interest for student nurses. In particular, the
Trauma Resuscitation Unit (TRU) receives
an extremely high volume of requests for
tours and observations. Working with
Cyndy Ronald, BA, Clinical Practice
and Professional Development, Manager,
University of Maryland School of Nursing
(UMSON) Partnership Program, Suzanne
Sherwood, MS, RN, Clinical Nurse II,
TRU and Assistant Professor, UMSON,
and Lynn Gerber Smith, MS, RN, Senior
Clinical Nurse II, TRU, presented a lecture
on the history of trauma nursing to a group
of more than 40 student nurses.
Sherwood and Smith are nationally
recognized speakers on a variety of trauma
related topics. Sherwood, who has a
fascination with the history of trauma care,
presented a case study on the medical and
nursing care of General Stonewall Jackson,
who sustained his injuries during the
American Civil War. As part of the TRU
staff, Sherwood and Smith work with the
Air Force C-STARS in the training and
education of Air Force personnel.
The presentation also included
advanced technologies used in today’s
civilian and military trauma care. The
closing case study focused on the passion
that Sherwood and Smith mutually share
for treatment and care of trauma patients.
One student who attended the presentation
commented, “Listening to Sherwood and
Smith was like listening to one presenter –
they could finish each others sentences.”
Following the presentation, the
participants were given a tour of the trauma
center, which included the helipad, TRU,
Lynn Gerber Smith and student nurses
hyperbaric chamber, and various trauma
inpatient units. Since the presentation and
tour were well received, the content will be
offered at the UMSON on an annual basis.
Shock Trauma Nurses continued from page 22.
For the second consecutive year,
the Trauma Resuscitation Unit (TRU)
nursing staff had a poster accepted at
this annual conference. Staff nurses
Diana Clapp, BSN, RN, CCRN, CEN,
NREMT-P, Senior Clinical Nurse II, and
Amanda Larsen, AS, RN, Clinical Nurse
II, were selected to present their poster,
“Improving Efficiency in Trauma Patients.”
Additionally, Clapp and Larsen were one
of four poster presenters selected by the
abstract review committee as oral abstract
winners for evidenced-based practice.
Working with Deborah Stein, MD,
MPH, FACS, FCCM, Associate Professor
of Surgery, Medical Director, Neurotrauma
Critical Care, Chief, Section of Trauma
Critical Care, Department of Surgery
and Kristin Seidl, PhD, RN, Director of
Quality and Patient Safety Officer, Clapp
and Larsen conducted a retrospective
review of radiation exposure, repeat
radiology testing, and staff satisfaction in
patients transferred to STC prior to and
after implementation of a radiographic
image importation process. This process
allows radiographic studies, like CT and
X-rays, performed at other hospitals to
be imported to the radiology system at
STC. Clapp and Larsen noted that after
implementation, patients underwent
fewer repeat radiographic studies, were
exposed to less radiation, and practitioner
satisfaction increased, as they were able to
immediately review films and formulate a
plan of care. Note: Clapp and Larsen wish
to acknowledge the assistance of Roy Ball,
MS, CRNP, ACNP-BC, CCNS, Clinical
Nurse Specialist, TRU and Ellen Plummer,
DL, MJ, MSN, MBA, RN, CCRN, Senior
Clinical Nurse II, TRU with this project.
The Shock Trauma Acute staff was
also well represented at the meeting and
shared their poster, “Hourly Rounding on
an Acute Care Trauma Unit.” Katherine
Mulligan Vann, BSN, RN, Senior Clinical
Nurse II and Shanna Hartman, BSN,
RN, Senior Clinical Nurse II, presented
their patient and staff satisfaction scores
before and after implementation of hourly
rounding. Since implementation of
hourly rounding, patients’ perceptions of
teamwork, safety, call bell responsiveness,
and overall staff responsiveness have all
Shanna Hartman
improved and now exceed the national
benchmarks. In addition, their already
low fall rate has decreased by 50%,
significantly below the national benchmark.
Other authors of the poster included
Shock Trauma Acute staff members
Allison Payne, BSN, RN, Senior Clinical
Nurse I, Mark Bauman, MS, RN, CCRN,
Nurse Manager, and Gena Stanek, MS,
RN, CNS-BC, Clinical Nurse Specialist.
23
22 South Greene Street
Baltimore, Maryland 21201
www.umm.edu
Clinical
Practice
Update
Pressure Ulcer Documentation
Clinical Intake/Triage
Practice Update : PressureForm
Ulcer Documentation
Changes in Electronic
&
Changes in Electronic Intake/Triage Form & Aranz Camera Rollout
Aranz Camera Rollout
What is the Aranz Wound Mangement System?
It is a UMMS initiative for standardized wound documentation across the continuum.
A major component of the Aranz system is a camera that will image and measure wounds, as well as interface with the clinical
information system.
Details and Benefits of Using the System
Who: The Wound Ostomy Continence Nurse (WOCN) team will pilot the Aranz camera only on patients admitted with pressure
ulcers and patients who develop a hospital acquired pressure ulcer.
Where : CS ICU, MICU, SICU, and Multi Trauma ICU.
When: April 29 to May 31, 2013 then expect to see expanded locations.
Why? The camera & enhanced documentation will assist us in identifying the size and location of any pressure ulcers present on admission
so that we can avoid them being categorized as hospital-acquired. The wound location must be specifically documented to match the picture taken
with the Aranz camera.
Wound/Ostomy/Continence R isks
section of the Intake and Triage form.
If the presence of Pressure Sores (Highlighted
Blue) is selected, the Wound Documentation
section generates and displays for the user to
complete.
Contact: Please contact a member of the WOCN team at ext. 8-6448 for more information
The nurse will document the presence
of pressure ulcers in the locations
noted in the screen shot. When
complete, select the blue circular arrow
to return to the intake/triage form.